Canadian Guidelines on Sexually Transmitted Infections

Section 4 - Management and Treatment of Specific Syndromes

Syndromic Management of Sexually Transmitted Infections

Syndromic Approach

Diagnosis of a syndrome according to
standard criteria predicts the likelihood that a specific pathogen or pathogens
is/are present and thus facilitates initiation of appropriate empiric treatment
at the first visit rather than deferring treatment until there is microbiological
confirmation. In the context of variable access to laboratory testing and
variable rates of follow-up, the syndromic approach takes on greater relevance
in controlling transmission and negative sequelae. See Table 1, below,
for the management of sexually transmitted infection (STI) syndromes.

While the syndromic approach is an
important tool in the control of STIs and their sequelae, management by
syndrome alone is inadequate because infections with important pathogens such
as Chlamydia trachomatis and Neisseria gonorrhoeae may be present
without any symptoms or findings. Although an infection may be suspected
because of disease in a partner or the presence of another STI, the infection
may be diagnosed only by using a specific laboratory test. Thus, in managing
STIs, diagnosis by syndrome and laboratory diagnosis by testing for specific
organisms are both important and complementary. Consult the chapters of the Management
and Treatment of Specific Infections section for details on the diagnosis,
treatment and management of specific infections.

Table 1. Syndromic approach to the management of sexually transmitted infections(Patients
may present with more than one STI; this table provides an outline of
investigations and relevant chapters where more in-depth information can be
found. In many cases, screening for other STIs should be carried out.)

For women without a cervix, see Gonococcal Infections and Chlamydial Infections chapters for
specimen-collection recommendations

As above

As above

For high-risk individuals where no
testing/microscopy is available or follow-up is not assured, treat for
bacterial vaginosis, Vulvovaginal candidiasis, trichomonas, chlamydia and
consider treating for N. gonorrhoeae if
local prevalence is high or sexual contact occurred in a region with high
prevalence.

Intestinal
and Enteric Syndromes:

Proctitis

Proctocolitis

Enteritis

Varies according to specific syndrome:

Mucopurulent rectal discharge

Anorectal pain

Constipation

Bloody stools

Diarrhea

Nausea

Abdominal pain/cramps

Bloating

Fever

Varies according to specific syndrome:

N. gonorrhoeae

C. trachomatis (LGV and non-LGV serovars)

T. pallidum

Herpes simplex
virus

Entamoeba
histolytica

Campylobacter spp.

Salmonella spp.

Shigella spp.

Giardia lamblia

Specimen collection should be adapted to clinical
presentation and patient history

By anoscopic
exam routinely obtain:

Rectal swab for
gonorrhea culture and chlamydia culture or NAAT (NAAT is not approved for
rectal specimens at this time)